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Cardiac Arrest During Coronary Catheterization

Question Type:
Full Question:
Among adults who have a cardiac arrest in the cardiac catheterization laboratory  (P), does does any special intervention or change in care (eg, catheterization during CPR, cardiopulmonary bypass, balloon pump, different timing of shocks)  (I), compared with compared with standard resuscitation care (eg, CPR, drugs, and shocks according to 2010 treatment algorithm)  (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC (O)?
Consensus on Science:
There were no comparative studies evaluating the survival benefit of mechanical CPR; however, individual noncomparative case series reported variable survival rates. For the critical outcomes of survival with favorable neurologic/functional outcome at discharge, 30 days, 60 days, 90 days, 180 days, and 1 year, and the outcomes of survival at 30 days, 60 days, 90 days, and 180 days, and 1 year, no studies were identified.For the critical outcomes of survival to discharge and survival to 6 months, and the important outcome of ROSC, very-low-quality evidence (downgraded for very serious imprecision and risk of bias) from 1 observational study(Tsao 2012, 530) compared ECLS with intra-aortic balloon pump and medical therapy for cardiogenic shock during PCI for STEMI. There were 21 subjects with cardiac arrest during PCI, and all survivors were in the ECLS group.
Treatment Recommendation:
We suggest the use of ECLS as a rescue treatment when initial therapy is failing for cardiac arrest that occurs during coronary catheterization (weak recommendation, very-low-quality evidence).Values, Preferences, and Task Force InsightsIn making this weak recommendation, the task force puts a higher value on usual ALS measures such as defibrillation. We have not made a specific recommendation here regarding the use of automated mechanical chest compressions, because we found no studies that addressed this question. We have suggested previously that automated mechanical chest compression devices are a reasonable alternative to high-quality manual chest compressions in situations where sustained high-quality manual chest compressions are impractical or compromise provider safety. This earlier weak recommendation could, therefore, apply to cardiac arrest during coronary catheterization. ECLS encompasses ECPR. We have already suggested ECPR is a reasonable rescue therapy for selected patients with cardiac arrest when initial conventional CPR is failing in settings where this can be implemented.
CoSTR Attachments:
2015 ALS PCI CoSTR StatementDraft_n.docx    
Bias and Data copy5_n.xlsx    

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